Objectives and Scope: Parental HIV has a major impact on surviving children through orphanhood and family economic constraints. We conducted a retrospective cohort study with 10 years of follow-up to assess the magnitude of the impact in several areas, including age at orphanhood, fostering, household structure/wealth and education.

Methods: Nearly 200 HIV positive and 400 HIV negative individuals were traced along with spouses and offspring. Of the children, 1980 were eligible for inclusion. Interviews were conducted with living individuals(or close family informants for those who had died or left the district).

Results:Age at orphanhood: The paternal orphanhood rate was 5 times higher for children born to parents where at least one was HIV-positive compared to those born to HIV-negative parents, 8 times higher for maternal orphanhood, and 16 times higher for double orphanhood. Observed rates predict that, for children born an HIV-positive parent, by age 15, 70% of surviving children will be paternal orphans, 50% maternal orphans, and 29% double orphans (compared with 18%, 9% and 3% respectively for children born to HIV-negative parents).

Other impacts: Data on fostering, household structure/wealth and education will be presented, demonstrating the broad impact of orphanhood. The reason for orphanhood (ie whether HIV related or otherwise) appeared to be important only for the effect on secondary school attendance. Some resulting household structures (eg mother headed households) are particularly poor in household assets.

Conclusions: The impact of parental HIV on orphanhood is huge. Most children orphaned by HIV become so during school age. The impact on fostering, household structure/wealth and education is substantial (data will be presented). Recommendations:Efforts to mitigate the impact of orphanhood (irrespective of cause) on children should be focussed on school age children. Mother headed households should be targeted. Anti-retroviral therapy for HIV-positive parents has the potential to massively reduce the incidence of orphanhood.